Rectocele plication: description of a novel surgical technique and review of clinical results.

INTRODUCTION AND HYPOTHESIS: A rectocele is the bulging of the anterior rectal wall into the posterior vaginal compartment. The route of surgical repair can be transvaginal, transrectal or abdominal. The aim of this retrospective study is to describe a novel transvaginal surgical procedure and investigate the associated subjective and objective clinical outcomes. METHODS: Database records were retrieved for all women who underwent a rectocele plication for the period from January 2010 until December 2015 in a referral urogynecology unit with a minimum follow-up period of 12 months. This transvaginal technique entails a plication of the anterior rectal wall by suturing of the rectal muscularis layer. Clinical findings and quality of life (QOL) metrics were evaluated and reported on. RESULTS: One hundred thirty-nine women met the initial inclusion criteria with full data available for 123. The presenting symptoms included a vaginal bulge in 73 (52.5%), overactive bladder (OAB) in 73 (52.5%), obstructed defecation (OD) in 49 (35.3%) and anal incontinence (AI) in 35 (25.2%). The majority of women (n = 72, 51.8%) had stage 3-4 posterior prolapse. The mean follow-up period was 27 ± 15 months. The postoperative symptoms were significantly improved for all, except AI (p = 0.43). There was a significant improvement in posterior prolapse (p < 0.001) with the majority of women noted to have a stage 0 or 1 (n = 109; 88.6%) posterior prolapse at follow-up. CONCLUSIONS: The rectocele plication is a novel surgical technique with good subjective and objective clinical outcomes in the medium term.

Validation of the PFDI-20 and PFIQ-7 quality of life questionnaires in two African languages.

INTRODUCTION AND HYPOTHESIS: Self-administered quality of life (QOL) questionnaires provide objective evaluation of an individual's symptoms. The Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) are condition-specific short form questionnaires. There are very few validated QOL questionnaires for women in Africa. The aim of this study was to validate these questionnaires in African women for the Afrikaans and Sesotho languages. METHODS: Patients with pelvic floor disorders completed the questionnaires at baseline, 1 week later and after 6 months. A control group of women not known to have pelvic floor disorders completed the questionnaires at baseline and 1 week later. Psychometric properties tested were internal consistency, reliability, construct validity and responsiveness. RESULTS: In each language group, 100 control and 100 study participants completed the scheduled rounds. Internal consistency, as measured by the Cronbach's alpha value, was good for the PFDI-20 (0.71-0.89) and the PFIQ-7 (0.81-0.89) for both the Afrikaans-speaking and the Sesotho-speaking patients. The test-retest reliability showed very good intraclass correlation coefficients of 0.89-0.99 across all scales of both questionnaires and in both language groups. The construct validity was confirmed as was the responsiveness to treatment for both questionnaires. CONCLUSIONS: The Afrikaans and Sesotho versions of the PFDI-20 and PFIQ-7 are reliable and valid instruments that can be used in women with pelvic floor disorders speaking these languages.

Effect of vaginal infiltration with ornipressin or saline on intraoperative blood loss during vaginal prolapse surgery: a randomised controlled trial.

INTRODUCTION AND HYPOTHESIS: Hydrodissection incorporating different types of vasoconstrictors is commonly used in vaginal prolapse surgery. There is little evidence as to whether it adds clinical value or whether it exposes the patient to unnecessary risk. The aim of this study was to compare the effect of a vasoconstrictor compared with saline alone on operative blood loss and cardiovascular parameters in a randomised clinical trial setting. METHODS: Patients undergoing vaginal prolapse surgery were randomised to an ornipressin (Por-8, Ferring) solution or saline alone for hydrodissection. The surgeon and patient were blinded to the solution used. Operative blood loss was accurately quantified and blood pressure and pulse readings recorded Pre, intra- and postoperatively. RESULTS: Eighty women were randomised. There was a statistically significant difference in the median blood loss: 35 ml (1-209 ml) in the ornipressin group compared with 81 ml (2-328 ml) in the saline group, p = 0.03. There was no statistically significant difference in the median pre and postoperative blood pressure or pulse rate between groups. CONCLUSIONS: The use of a vasoconstrictor (ornipressin) resulted in a statistically significant decrease in operative blood loss during vaginal prolapse surgery. This occurred without any significant changes in measured cardiovascular parameters.

Pelvic organ prolapse in the neonate: report of two cases and review of the literature.

Pelvic organ prolapse (POP) in the new-born baby is a rare though well-acknowledged clinical condition. We present two cases of complete utero-vaginal prolapse in new-born babies. Both infants were otherwise healthy and neurologically normal in their clinical presentation and evaluation. The prolapse was successfully managed with a non-surgical approach. There appears to be two distinct forms of POP in newborns based on the available literature. There are those that occur in newborns with spina bifida (77 % of cases) and those that occur in neurologically intact newborns (23 %). The management of these two types are distinctly different and are discussed in greater detail in this report.